Protocol Overview

Note: Some Protocols contain images. You may click the thumbnails to preview the full image. To print Protocols with full size images, please add those Protocols to your Toolkit and Generate a Report.

Skin Cancer #170601

Protocol Release Date

November 12, 2010

Protocol Name From Source

The Expert Review Panel has not reviewed this measure yet.

Description of Protocol

The protocol developed by Quereux et al. (2010) includes a self administered questionnaire that captures the main skin cancer risk factors, such as skin type, presence of freckles and moles, occurrence of blistering sunburns and personal and family history of melanoma. After the respondent completes the questionnaire, the physician then examines the respondent regarding the number of nevi, freckling tendency, and phototype (hair and eye color, complexion and tanning ability). Then the physician checks the answers provided by the respondent and completes the questionnaire.

Specific Instructions

Questions 1-3 of the questionnaire for self-assessment of melanoma risk factors have been deleted. These questions asked the respondent’s age, gender, and occupation. The PhenX Skin, Bone, Muscle and Joint Working Group (WG) recommends that this information be obtained via the PhenX measures titled Current Age, Gender, and Current Employment Status, respectively.

The Working Group recommends that as an alternative to a physician, a trained technician can conduct the physical examination.

Protocol

Self-Assessment of Melanoma Risk Factors

Answer each question by putting a cross in the corresponding square (left column)

4. Did you have one or more severe blistering sunburn as a child or teenage?

[ ] Yes

[ ] No

5. Did you live for more than one year in a country where sunshine is high (Africa, French West Indies, South of United States, Australia…)

[ ] Yes

[ ] No

6. Have you been diagnosed with melanoma in the past (it’s a skin cancer, arising in melanocytes, skin cells that make skin pigment)?

[ ] Yes

[ ] No

7. Has any of your first degree relatives (parents, children, brother or sister) ever had melanoma?

[ ] Yes

[ ] No

[ ] Don’t know

Note from the Skin, Bone, Muscle and Joint Working Group: After completing a physical examination, the physician selects answers for questions 8-14 below. This selection is based on the physical examination. The questions are not asked of the patient.

Physician’s Assessment of Melanoma Risk Factors

8. What type of skin do you have?

[ ] Skin-type I

[ ] Skin-type II

[ ] Skin-type III

[ ] Skin-type IV

[ ] Skin-type V

[ ] Skin-type VI

9. Do you have freckles?

[ ] Yes

[ ] No

10. How many moles do you approximately have on the whole body?

[ ] > 50

[ ] < 50

11. Did you have one or more severe blistering sunburn as a child or teenage?

[ ] Yes

[ ] No

12. Did you live for more than one year in a country where sunshine is high (Africa, French West Indies, South of United States, Australia…)

[ ] Yes

[ ] No

13. Have you been diagnosed with melanoma in the past (it’s a skin cancer, arising in melanocytes, skin cells that make skin pigment)?

[ ] Yes

[ ] No

14. Has any of your first degree relatives (parents, children, brother or sister) ever had melanoma?

Did you have one or more severe blistering sunburn as a child or teenage?

4

N/A

PX170601_Self_Assessed_Country_High_Sunshine

PX170601050000

Did you live for more than one year in a country where sunshine is high (Africa, French West Indies, South of United States, Australia...)

4

N/A

PX170601_Self_Assessed_Melanoma

PX170601060000

Have you been diagnosed with melanoma in the past (it's a skin cancer, arising in melanocytes, skin cells that make skin pigment)?

4

N/A

PX170601_Self_Assessed_Melanoma_Family_History

PX170601070000

Has any of your first degree relatives (parents, children, brother or sister) ever had melanoma?

4

N/A

PX170601_Examiner_Assessed_Skin_Type

PX170601080000

What type of skin do you have?

4

N/A

PX170601_Examiner_Assessed_Freckles

PX170601090000

Do you have freckles?

4

N/A

PX170601_Examiner_Assessed_Moles

PX170601100000

How many moles do you approximately have on the whole body?

4

N/A

PX170601_Examiner_Assessed_Sunburn

PX170601110000

Did you have one or more severe blistering sunburn as a child or teenage?

4

N/A

PX170601_Examiner_Assessed_Country_High_Sunshine

PX170601120000

Did you live for more than one year in a country where sunshine is high (Africa, French West Indies, South of United States, Australia...)

4

N/A

PX170601_Examiner_Assessed_Melanoma

PX170601130000

Have you been diagnosed with melanoma in the past (it's a skin cancer, arising in melanocytes, skin cells that make skin pigment)?

4

N/A

PX170601_Examiner_Assessed_Melanoma_Family_History

PX170601140000

Has any of your first degree relatives (parents, children, brother or sister) ever had melanoma?

4

N/A

Selection Rationale

The questionnaire for self-assessment of melanoma risk factors was chosen because it has been vetted against other indexes, and for its ease of patient use, brevity, and ability to compare patient and physician assessment.

The questions in the protocol text section were originally numbered 4-10; these numbers have been changed to 1-7 and 8-14.

Life Stage

Adult, Senior

Language

English, French

Participant

Adults, aged 18–70

Personnel and Training Required

The interviewer must be trained and found to be competent (i.e., tested by an expert) in the conduct of physical examinations regarding nevi, freckling tendency, and phototype (hair and eye color, complexion and tanning ability).

Equipment Needs

A copy of the questionnaire for self-assessment of melanoma risk factors.